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Few treatments arouse as much controversy as long-acting naltrexone implants or injections which promise to block the effects of heroin for up to several months. But in the USA the injected form has been licensed for treating opioid dependence. This document offers official US clinical guidance to doctors undertaking the treatment.
REVIEW 2012 HTM file
Drug policy and the public good: evidence for effective interventions
Review of relevant research by an international team of leading researchers offers policymakers guidance on the interventions most likely on the evidence to achieve national policy aims in respect of illegal drug use.
STUDY 2010 HTM file
Favorable mortality profile of naltrexone implants for opiate addiction
Few treatments for opiate addiction arouse as much controversy as naltrexone implants. Inserted under the skin, these block the effects of heroin for up to several months - for some, a magic bullet, for others, an unsafe and ethically dubious experiment. More evidence from Australia that the overdose death risk is less than with oral forms of the drug.
In Russia, injecting detoxified opiate addicts with long-acting naltrexone which blocks opiates for a month meant more were able to stay off the drugs, findings which helped persuade US authorities to approve it for this role. Others argue this was precipitate given the lack of evidence on overdose protection.
In the first study of its kind opiate-dependent prisoners in Norway were randomly allocated to a six-month implant which blocks the effects of heroin or to methadone which substitutes for heroin as a way of bridging the period after release. Among the few interested in either option, they led to equivalent reductions in opiate use and crime.
STUDY 2010 HTM file
Treatment research in prison: problems and solutions in a randomized trial
In the first study of its kind, as a way of bridging the period after release opiate-dependent prisoners in Norway were randomly allocated to a six-month implant which blocks the effects of heroin or to methadone which substitutes for heroin. Many prisoners rejected treatment, wrongly believing they would sustain abstinence on release.
Despite being motivated to sustain abstinence and implanted with a drug which should have blocked the effects of opiates, in Norwegian studies most opiate-dependent patients used opiates and about a quarter did so repeatedly.
STUDY 2010 HTM file
Retention in naltrexone implant treatment for opioid dependence
In Norway over half the opiate dependent patients implanted with the opiate blocking drug naltrexone opted for another implant after six months when the first had worn off, giving themselves a year in which to construct a life no longer reliant on the effects of heroin.
REVIEW 2010 HTM file
Heroin anticraving medications: a systematic review
The observation that craving can precipitate relapse to heroin use or drop-out even among methadone-maintained patients led to this search for evidence that other medications can help suppress the urge to use; buprenorphine had the most extensive positive research record to date.
STUDY 2006 PDF file 162Kb
Long-acting depot naltrexone extends opiate abstinence
A long-acting version of the opiate blocking drug naltrexone nearly doubled the time heroin dependent patients were retained in abstinence-based treatment, creating an opiate-free space during which to begin the construction of non-addicted lifestyles.
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